腹腔镜胃癌根治术后腹腔游离癌细胞的变化及意义

Changes of peritoneal free gastric cancer cells and its significance in patients after laparoscopic radical gastrectomy

目的对比研究腹腔镜与开腹胃癌根治术后腹腔游离癌细胞的变化，探讨腹腔镜胃癌根治术的安全性及可行性。方法收集2006年4月至2008年6月间63例腹腔镜、61例开腹胃癌根治术患者术前、术后腹腔灌洗液，分别运用细胞学和荧光定量PCR方法检测腹腔游离癌细胞的阳性率和癌胚抗原（CEA）mRNA的表达变化，观察胃浆膜受侵面积与腹腔游离癌细胞阳性率的关系。结果腹腔镜组术后腹腔灌洗液游离癌细胞的阳性率为25．4％，与开腹组（29．5％）比较差异无统计学意义（P〉0．05）；腹腔镜组术后腹腔灌洗液CEA mRNA阳性率为41．3％，与开腹组（40．3％）比较差异亦无统计学意义（P〉0．05）。腹腔镜组术前、术后腹腔游离癌细胞均为阳性的病例，其浆膜平均受侵面积为（16．2±2．2）cm^2，而术前、术后游离癌细胞均为阴性的病例，其浆膜平均受侵面积为（5．3±0．8）cm^2，腹腔游离癌细胞的阳性率与浆膜受侵面积呈正相关（R^2=0．874，P=0．000）。结论腹腔镜胃癌根治术并不增加腹腔游离癌细胞的阳性检出率。

Objective To evaluate the safety and feasibility of laparoscopic radical gastrectomy on gastric cancer through comparison of peritoneal free gastric cancer cells detecting rates between laparoscopic and open radical gastrectomy. Methods Sixty-three patients received laparoscopic gastrectomy and 61 patients received open gastrectomy between April 2006 and June 2008 were included in this study. The peritoneal lavage fluid in those patients before and after the operation was collected. The cancer cell cytology and carcinoembryonic antigen （CEA） mRNA were detected with those samples. The relationship between peritoneal free gastric cancer cells and the area of cancer-invaded serosa was also observed. Results The positive rate of cytology in laparoscopic surgery was 25.4% in the peritoneal fluid after the operation, while it was 29. 5% in the open surgery, there was no significant difference between the two groups （P 〉0. 05）. The positive rate of CEA mRNA in the peritoneal fluid after the operation in the laparoscopic group was 41.3%, and was 40. 3% in the open group （P 〉0. 05）. The area of cancer-invaded serosa in patients with positive cytology before and after the operation in the laparoscopic group was （ 16.2 ±2.2） cm^2, and it was （ 17. 6±3.0） cm^2 in their counterparts in the open surgery group, while it was （5.3 ±0. 8） cm^2 in patients with negative cytology before and after the operation. The area of cancer-invaded serosa was positively correlated with the positive rate of cycology （ R^2 = 0. 874, P = 0. 000）. Conclusions Laparoscopic radical gastrectomy is not associated with a greater risk for peritoneal dissemination of cancer cells than the open technique.